Labial adhesions due to vulvar lichen sclerosus in young females: a rare case series

Keerthi B. Velagapudi; Mahesh R. Dammalapati; Bala M. K. Patibandla

doi:10.18203/2320-6012.ijrms20263264

Authors

Keerthi B. Velagapudi Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Krishna Dt., Andhra Pradesh, India
Mahesh R. Dammalapati Department of Urology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Krishna Dt., Andhra Pradesh, India
Bala M. K. Patibandla Department of Urology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Krishna Dt., Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263264

Keywords:

Lichen sclerosus, Vulvar leukoplakia, Labial adhesions, Urethral stenosis, Young female, Reconstruction

Abstract

Lichen sclerosis (LS) is a chronic inflammatory dermatosis primarily affecting the anogenital area. It commonly presents in postmenopausal women but may occur at any age. LS can cause extreme pruritic, pain and loss of vulvar architecture with resorption of the labia majora, minora and stenosis of the vaginal introitus and urethral meatus. In rare cases, it can lead to vulvar leukoplakia, labial adhesions, and urinary outflow obstruction. Here, we report 3 cases of young females presenting with urinary symptoms, labial fusion, and leukoplakia. Examination revealed labial fusion, and a white lesions involving labia majora. They underwent reconstruction. Biopsy confirmed LS with features of squamous leukoplakia and mild dysplasia. Early recognition and intervention in lichen sclerosus is crucial to prevent anatomical and functional complications. Multidisciplinary management is key for optimal outcomes in young patients.

References

Powell J, Wojnarowska F. Lichen sclerosus. Lancet. 1999;353(9166):1777-83.

Funaro D. Lichen sclerosus: a review and practical approach. Dermatol Ther. 2004;17(1):28-37.

Neill SM, Lewis FM, Tatnall FM, Cox NH. British Association of Dermatologists’ guidelines for the management of lichen sclerosus 2010. Br J Dermatol. 2010;163(4):672-82.

Kirtschig G. Lichen sclerosus-presentation, diagnosis and management. Dtsch Arztebl Int. 2016;113(19):337-43.

Edmonds EV, Hunt S, Hawkins D, Dinneen M, Francis N, Bunker CB. Clinical parameters in male genital lichen sclerosus: a case series of 329 patients. J Eur Acad Dermatol Venereol. 2012;26(6):730-7.

Fischer GO. Vulvar disease in pre-pubertal girls. Aust J Dermatol. 1999;40(2):63-70.

Nasca MR, Innocenzi D, Micali G. Association of lichen sclerosus and autoimmune diseases: a retrospective study of 532 patients. J Am Acad Dermatol. 1995;33(3):435-40.

Carlson JA, Ambros R, Malfetano J, Ross J, Grabowski R, Lamb P, et al. Vulvar lichen sclerosus and squamous cell carcinoma: a cohort, case control, and investigational study with historical perspective. Implications for chronic inflammation and sclerosis in the development of neoplasia. Hum Pathol. 1998;29(9):932-48.

Virgili A, Levratti A, Bernardini L, Corazza M. Vaginal involvement in lichen sclerosus: report of 4 cases. J Reprod Med. 2003;48(6):444-6.

Cooper SM, Gao XH, Powell JJ, Wojnarowska F. Does treatment of vulvar lichen sclerosus influence its prognosis? Arch Dermatol. 2004;140(6):702-6.

Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1-15.

Lewis FM, Tatnall FM, Velangi SS, Bunker CB, Kumar A, Brackenbury F, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018. Br J Dermatol. 2018;178(4):839-53.

Halonen P, Jakobsson M, Heikinheimo O, Rintala M-A. Long-term clinical course of vulvar lichen sclerosus: a prospective follow-up study. J Reprod Med. 2017;62(5-6):197-202.